Questions Remain Unanswered
Why was the volume reduction owing to combination treatment cited in such detail—where is the benefit for asymptomatic patients? Why was iodine not recommended as first-line treatment?
The standard follow-up interval is set at 6–18 months—why not gradually longer intervals? What is the number needed to screen (NNS) with regard to preventable, high-risk disease courses?
Under the heading “Laboratory tests,” you recommend general calcitonin measurements; under “Clinical follow-up and further care after treatment,” you write: “History-taking, physical examination, ultrasonography, and TSH measurement generally constitute an adequate clinical follow-up.” Is measuring calcitonin therefore useful only in the initial consultation for a nodule? Or in every consultation? What would be the NNS for this measure, and what would be the costs?
In view of the cited prevalence this would involve one-fifth of the adult population. In my opinion, it is not enough to cite guidelines from medical specialty societies in this context. One would expect that in a review article that addresses all doctors, any recommendations would at least briefly have discussed aspects of benefits (NNS) and harms (number needed to harm, NNH).
Dr. med. Peer Laubner
Facharzt für Allgemeinmedizin,
GP Laubner Turner Protz, Büdingen,
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Führer D, Bockisch A, Schmid KW: Euthyroid goiter with and without nodules—diagnosis and treatment. Dtsch Arztebl Int 2012; 109(29–30): 506–16. VOLLTEXT|